Oct 15, 2010 4:09 AM

Given that I'm 8 days from the Beijing marathon, I'm anxious for feedback from runners with more injury experience/knowledge. After a 17km run on October 6 I noticed the onset of a sharp ache in the high on the front of my thigh. It's hard to pinpoint the precise location, but it seems to be a small cluster of sharp twinges in various places across my upper left thigh from my hip. The pain is associated with impact only. No impact, no pain. Impact is not limited to running, but also includes standing up and walking (the first step on my left leg), getting off my bicycle and landing on my left leg (since I dismount on the left side), hopping on my left leg, etc. Here's the weird part: The pain actually diminishes as I run. The pain is noticeable and bothersome in the first few km, but by kilometer 10 or so I more or less forget about the pain. Since the onset of this pain almost 10 days ago, I've run four 7+ km runs and a 21.1 km (half marathon) run without any problems (and in fast times by my usual standards). Can't I rule out a stress fracture for this reason? Isn't the pain from a stress fracture supposed to increase with distance to the point of agony? I've done virtually every test I can think of: resistance tests (flexion strength), range of motion tests, abduction strength, adduction strength, Ober's Test for ITB syndrome, the Trendelenberg Test (standing on one leg), Patrick's Test (or the faber test), the Thomas Test, Ely's Test, the Log Roll Test, the femur bend/pressure test for femur stress fractures, the hang-a-leg-off-the-side-of-a-bed test, etc. My muscle strength is fine and there's no pain whatsoever in any of the tests on this long list. The only symptom I have is what I described above: impact. In fact, impact is pretty painful, causing me to wince. But again, I can run through it pretty easily to the point that I forget about it after I'm sufficiently warmed up. I'm treating it with ice, forward lunge stretches, IT band stretches, groin stretches, and self-massage with a rolling pin and tennis ball on the thigh muscles. I think it's getting a little better. For sure it's not getting worse. Since I'm in China, I'm not planning to see a doctor about this. My plan is to proceed with the full marathon in 8 days and hope for the best. Any thoughts you have would be GREATLY appreciated. Thank you!

The worse case scenario is the problem you are experiencing is a stress fracture of the femur. If you try to run through a stress fracture the worse case scenario is the stress fracture could become an overt traumatic fracture. A fracture of the femur is serious injury, but a fracture of the neck of the femur is a very serious injury. If a fracture occurs in the neck of the femoral bone is can lead to death of the femoral head.

I'd be very grateful if you clarify this worst-case scenario for me. Everything I read about stress fractures indicates the pain worsens with distance. Furthermore, I did the femur "hang test" (http://www.sportsinjuryclinic.net/cybertherapist/front/frontthigh/femur_stress_fracture/1-femur_stress_fracture.php) and the "log roll test" with no pain whatsoever. After posting my original query, I went out and ran a quick 6km on a treadmill. The treadmill allowed me to focus more on the location and character of the pain than I'm able to do out on the pavement. Here's what I can add: First, whereas I had been under the impression before that the pain was focused on the left hip, I now have the sense the pain almost circles the very top of my anterior thigh (almost but not quite extending to the groin). Second, the pain noticeably diminishes after 2km and almost entirely disappears after 4km. Third, even at its worst, the pain never exceeds 3 on the 10-point pain scale. I'm really anxious to understand the risk of a femur or femural neck stress fracture given that my specific symptoms do not seem to conform to the typical profile (at least as I understand it). Thanks so much!

Actually, many of your symptoms DO indicate stress fracture, just because a few don't does not mean you can "rule out" a stress fracture. I was a case in which I had very few symptoms of a femoral neck stress fracture - my only thing was pain and soreness in my hip that didn't go away and an affected gait. I had great range of motion, my pain lessened as I ran, I didn't even have impact pain as you describe but yet I was diagnosed with a stress fracture. They were pretty positive I didn't have one based on my symptoms thinking it was a muscle tear, but yet they wanted me to get the MRI to 1) confirm a muscle tear and 2) rule out that 10% chance they thought it COULD be a stress fracture. It was that 10% freak chance.

The point being, you can't look at the symptoms and hope on hope that you DON'T have something because a few of the symptoms don't match up. Hip injuries are tricky and difficult to diagnose because often you will have symptoms of one injury but not all but have symptoms of yet 5 other injuries. You really should get a proper diagnosis from a doctor - hopefully it isn't a stress fracture, but maybe it is. And there are other hip injuries that can be quite serious as well but others are OK to run on or can be taken care of with a little therapy or a cortizone shot to get you through the worst part. Proceeding with the marathon and hoping for the best could be really dangerous - IF it is a stress fracture and you were to run on it, it could complete the fracture. That would put you out for months requiring surgery to put a pin in your hip and being on crutches for months. I know this is an important race to you, but you need to get a diagnosis and find out if it's an injury that you CAN and should run on. When I had my injury, I was gearing up for my big goal race and I was not allowed to run it. It was devastating. But I had to keep asking myself, "Do you want to run THIS race or do you want to run the rest of your life?" and the choice was easy. You need to find some way to get into a doctor if you can because it MIGHT be nothing but it MIGHT be really serious. Are you willing to take that risk?

Good news: the MRI results do not suggest a stress fracture. This morning I went to the Beijing University Number 3 Hospital, which has one of the very few sport medicine clinics in Beijing. There's nothing in the world like a Chinese hospital. The sheer volume of people seeking (and obtaining) medical help totally boggles the mind. Although the sports clinic was already full for the day, I managed to squeeze myself in. And although the MRI machine was booked through next Wednesday, I managed to squeeze myself in. Although the official radiology report and the full-size printed images won't be available until Tuesday afternoon, I managed to get a sports doctor and another doctor to examine the images on a computer screen. Neither doctor was able to find any evidence whatsoever of a stress fracture in the upper femur/femoral neck. The MRI includes both hips, so they were able to compare the two. They couldn't spot any differences. Preliminary diagnosis: soft tissue pull/strain (although they also said the muscles don't look too bad). Yeah, it's almost uselessly vague, and it's based on nothing more than a look at the MRI images, but I got my money's worth. One of the reasons I don't like Chinese hospitals is that doctors never spend more than about 45 seconds with a given patient.... But of course their clinical experience is unparalled since they see so many people. And the price is right: the doctor's consultation fee was less than $1, and the MRI (using a state-of-the-art GE machine) cost $150 -- almost makes me embarrassed to submit the claim to my insurance company.... Afterwards I went for a 2-hour massage, most of which was focused deeply and intensively on my thigh. I'm feeling *so* much better.

I just wanted to thank the two of you again for pushing me to get a definitive answer. Yesterday I showed the MRI images to a bone/joint doctor at Haidian Hospital. He said there was no evidence whatsoever of a stress fracture (no edema, no fracture), but also advised me to go back to the sports clinic at the Beijing University Number Three Hospital to be 100% sure (apparently sports medicine, even when it involves bone stuff, is completely different from regular bone/joint medicine). Today I saw a specialist in bone fractures. After examining the MRI images he conclusively ruled out a stress fracture. He also did all the manual tests (log roll, palpatation of the hip, etc.). His diagnosis: overuse/overtraining leading to soft tissue pain. He gave me the green light to run the marathon. Now that I've completed my taper 3 days in advance of the race, my thigh/hip feels markedly better. In fact, today was my first day in which I didn't feel anything unusual at all in the area. Had you not pushed me to get the right tests, I would have been stressed out about running. I can't thank you enough.

GREAT! I'm really glad to hear that it wasn't anything too serious and that you are cleared to run the marathon. It can be devastating to get injure so close to your goal race. And I'm also glad it seems the doctors there were so thorough. That's amazing. Over in the states you probably wouldn't have gotten such great medical care. And that's great that a few days off have helped it a lot. Good luck in your race - come back and let us know how it goes.

I survived! 4:02:58. Feeling pretty good, as this was my first marathon, I'm 41, and the weather was miserable yesterday (temperature 48 degrees, rain, and strong winds up to 18mph with gusts almost 30mph). The winning time was 2:14:45, 8 minutes slower than last year's (http://www.usatoday.com/sports/olympics/2010-10-24-1169336510_x.htm). My muscles, especially my calves, are SO much sorer than they were after my longest training run of 22.5 miles. I wonder if the weight of my water-logged shoes caused my calves to work extra hard, or if cold temperatres makes muscles tighter.... Anyway, all things considered, I'm really happy. The original source of pain (upper left thight/left hip) is probably the only part of my body that doesn't hurt..... BTW, I wouldn't recommend the Beijing Marathon. It was very poorly organized.

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